Healthcare Provider Details

I. General information

NPI: 1053864546
Provider Name (Legal Business Name): MARISOL RIOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 OSWELL STREET, STE #119
BAKERSFIELD CA
93306
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-872-3001
  • Fax:
Mailing address:
  • Phone: 661-861-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberASW78754
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW78754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: